Relationship Between Residents’ Physiological Stress and Faculty Leadership Skills in a Department of Surgery

Egide Abahuje*, Susheel Reddy, Claudia Rosu, Katherine A. Lin, Lara Mack, Catherine Valukas, Michael Shapiro, Hasan B. Alam, Amy Halverson, Karl Bilimoria, Jamie Coleman, Anne M. Stey

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Background: Leadership skills of team leaders can impact the functioning of their teams. It is unknown whether attending surgeons’ leadership skills impact residents’ physiological stress. This study sought to (1) assess the relationship between attending surgeons’ leadership skills and residents’ physiological stress and (2) to characterize lifestyle behaviors associated with resident physiological stress. We hypothesized that strong attending leadership skills would be associated with low resident physiological stress. Study Design: This prospective observational cohort study was conducted at a single urban, academic medical center in the US, over 12 months. Residents were enrolled during their rotation of 1 to 2 months on the Trauma and ICU services. The primary predictor was the attending surgeons’ leadership skills that were measured using a weekly survey filled out by residents, using the Surgeons’ Leadership Inventory (SLI). The SLI uses a 4-point Likert scale to measure surgeons’ leadership skills across eight domains. The primary outcome was residents’ physiological stress, which was measured by their Heart Rate Variability (HRV). We recorded the residents’ HRV with a WHOOP strap that was continuously worn on the wrist or the bicep. We used multivariate repeated measures gamma regression to assess the relationship between attending leadership skills and residents’ physiological stress, adjusting for hours of sleep, age, and service. Results: Sixteen residents were enrolled over 12 months. The median attending surgeons’ leadership score was 3.8 (IQR: 3.2–4.0). The median residents’ percent of maximal HRV was 70.8% (IQR: 56.7–83.7). Repeated measure gamma regression model demonstrated a minimal nonsignificant increase of 1.6 % (95% CI: -5.6, 8.9; p-value = 0.65) in the percent of maximal HRV (less resident physiological stress) for every unit increase in leadership score. There was an increase of 2.9% (95% CI= 1.6, 4.2; p-value < 0.001) in the percent of maximal HRV per hour increase in sleep and a significant decrease of 10.9% (95% CI= -16.8, -5.2; < 0.001) in the percent of HRV when working in the ICU compared to the Trauma service. Conclusion: This study revealed that more residents’ sleep was associated with lower physiological stress. Attending surgeons’ leadership skills were not associated with residents’ physiological stress.

Original languageEnglish (US)
Pages (from-to)1129-1138
Number of pages10
JournalJournal of Surgical Education
Issue number8
StatePublished - Aug 2023


  • cognitive load
  • heart rate variability
  • nontechnical skills
  • physiological stress
  • surgeons’ leadership
  • trauma

ASJC Scopus subject areas

  • Education
  • Surgery


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